2005—2014年广州医科大学附属第一医院细菌耐药性监测

发布时间：2018-07-10 07:13

本文选题：细菌耐药性监测 + 药物敏感性试验　；参考：《中国感染与化疗杂志》2016年02期

【摘要】：目的了解2005—2014年广州医科大学附属第一医院临床常见分离菌对抗菌药物耐药性变迁,为临床治疗提供可靠依据。方法采用自动化仪器和纸片扩散法(K-B法)对临床分离株作药敏试验,并按美国临床和实验室标准化协会(CLSI)2014年标准判断药敏试验结果,数据分析采用WHONET 5.6软件,对10年间的资料作回顾性调查分析。结果2005—2014年该院共收集非重复分离菌23 258株,革兰阴性菌为79.4%(18 461/23 258),革兰阳性菌20.6%(4 797/23 258)。甲氧西林耐药金黄色葡萄球菌(金葡菌,MRSA)各年分离率为16.8%~59.1%,总体在2011年之后上升明显,达50%以上,未发现对万古霉素、替考拉宁、利奈唑胺耐药株。检出利奈唑胺耐药粪肠球菌1株(MIC=8 mg/L)。未发现替考拉宁、万古霉素耐药肠球菌。青霉素耐药肺炎链球菌占14.4%(29/201)。从2005—2014年,产ESBL大肠埃希菌检出率由23.5%升到54.9%,产ESBL肺炎克雷伯菌从22.1%升至33.9%。产ESBL株对头孢菌素类、氨基糖苷类、喹诺酮类、甲氧苄啶-磺胺甲唑的耐药率明显高于非产ESBL株。共分离耐碳青霉烯类抗生素肠杆菌科细菌(CRE)410株,各年度分离CRE占肠杆菌科细菌3%左右,但2011、2012年分离的CRE飙升至9.2%(117/1 271)、7.4%(122/1 638),以肺炎克雷伯菌、大肠埃希菌为主。铜绿假单胞菌对喹诺酮类、氨基糖苷类、第三代和第四代头孢菌素类药物耐药性呈逐年下降趋势,其中2005—2014年耐左氧氟沙星从35.7%降至11.3%,耐庆大霉素从25.6%降至8.1%,耐头孢吡肟从29.3%降至10.0%。鲍曼不动杆菌对碳青霉烯类药物耐药率2005—2008年保持20%以下,2009年对亚胺培南和美罗培南耐药率升至40.1%和36.2%,至2014年达到64.2%和64.7%。广泛耐药鲍曼不动杆菌从2009年开始出现,至2014年分离率达到14.4%。结论该院10年细菌耐药性变迁显示,革兰阴性菌耐药性呈上升趋势,尤其CRE和耐碳青霉烯类鲍曼不动杆菌更应引起关注。
[Abstract]:Objective to investigate the changes of antimicrobial resistance of common isolated bacteria in the first affiliated Hospital of Guangzhou Medical University from 2005 to 2014, and to provide reliable evidence for clinical treatment. Methods the drug sensitivity test of clinical isolates was performed by automatic instrument and disk diffusion (K-B method). The drug sensitivity test results were judged according to the 2014 standard of American Association of Clinical and Laboratory Standardization (CLSI). The data were analyzed by WHONET 5.6 software. The data of 10 years were analyzed retrospectively. Results from 2005 to 2014, 23 258 non-repetitive isolates were collected, 79.4% (18 461 / 23 258) Gram-negative bacteria and 20.6% (4797 / 23,258) Gram-positive bacteria. The isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) in each year was 16.8%, which increased significantly after 2011, reaching more than 50%. No vancomycin, teicoplanin and linazolamide resistant strains were found. A strain of Enterococcus faecalis (MIC8 mg / L) was identified. Teicoplanin and vancomycin resistant Enterococcus were not found. Penicillin resistant streptococcus pneumoniae accounted for 14.4% (29 / 201). From 2005 to 2014, the detection rate of ESBL-producing Escherichia coli increased from 23.5% to 54.9%, and the ESBL-producing Klebsiella pneumoniae increased from 22.1% to 33.9%. The resistance rate of ESBL-producing strains to cephalosporins, aminoglycosides, quinolones and trimethoprim sulfamethazoles was significantly higher than that of non-ESBL producing strains. A total of 410 strains of Enterobacteriaceae (CRE) resistant to carbapenem were isolated. CRE accounted for about 3% of Enterobacteriaceae bacteria in each year, but the CRE isolated in 2012 soared to 9.2% (117 / 1 271) and 7.4% (122 / 1 638), mainly Klebsiella pneumoniae and Escherichia coli. The resistance of Pseudomonas aeruginosa to quinolones, aminoglycosides, third and fourth generation cephalosporins decreased year by year. In 2005-2014, levofloxacin tolerance decreased from 35.7% to 11.3%, gentamicin resistance decreased from 25.6% to 8.1%, cefepime resistance decreased from 29.3% to 10.0%. The resistance rate of Acinetobacter baumannii to carbapenem remained below 20% from 2005 to 2008. In 2009, the resistance rate to imipenem and meropenem rose to 40.1% and 36.2%, and to 64.2% and 64.7% by 2014. Acinetobacter baumannii, a widely resistant bacterium, began to appear in 2009, and the isolation rate reached 14.4% in 2014. Conclusion the change of bacterial resistance in this hospital in 10 years shows that the resistance of Gram-negative bacteria is on the rise, especially CRE and Acinetobacter baumannii which are resistant to carbapenes should be paid more attention to.
【作者单位】：广州医科大学附属第一医院呼吸疾病国家重点实验室;广州医科大学附属第一医院检验科微生物室;
【分类号】：R446.5

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